title: Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra for the early recovery of urinary continence after retropubic radical prostatectomy: a prospective case-control study.
abstract: OBJECTIVE
  To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy.
  
  
  METHODS
  This was a prospective single-center, case-control study. A total of 40 consecutive patients with organ-confined prostate cancer were submitted to radical prostatectomy with the preservation of the muscular internal sphincter and the proximal urethra (group 1), and their outcomes were compared with those of 40 patients submitted to a standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7 and 30 days, and 3 and 12 months after removal of the catheter.
  
  
  RESULTS
  Group 1 had a faster recovery of early continence than group 2 at day 3 (45% vs 22%; P = 0.029) and at day 7 (75% vs 50%; P = 0.018). Considering the number of pads, group 1 had a faster recovery of continence at 3, 7 and 30 days, and also had less incidence of severe incontinence. There was no statistically significant difference in terms of continence at 3 and 12 months among the two groups. Multivariate logistic regression analysis showed that surgical technique and young age were significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins.
  
  
  CONCLUSIONS
  Our modified technique of radical retropubic prostatectomy with preservation of the smooth muscular internal sphincter, as well as of the proximal urethra during bladder neck dissection, results in a significantly increased urinary continence at 3, 7 and 30 days after catheter removal, with a minor incidence of severe incontinence. The technique is also oncologically safe, and it does not increase the operative duration of the procedure.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Cristian Vincenzo
authors.initials: CV
authors.lastname: Pultrone
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.forename: Martina
authors.initials: M
authors.lastname: Rossi
authors.forename: Matteo
authors.initials: M
authors.lastname: Cevenini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D016496:Incontinence Pads; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000379:methods; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*
keywords: bladder neck; radical prostatectomy; sphincter; urethra; urinary continence